You don't need neuropsych testing to dx autism. But, for best practice you do need an evaluation. The specifics depend on age and communication/functioning, though.
My under five eval looks like:
- rating scales from multiple informants (usually ASRS and something else)
- ADOS-2 (often needed for kids to get access to ABA services by insurances)
- I use a rip off of the ADI-R to qualitatively probe/document behaviors
- a measure of adaptive functioning (often needed to get services from the state dept of dev. disabilities to document significant functional limitations)
- I might toss a nonverbal IQ test them, if I feel like it.
My six year and up eval looks like:
- rating scales from multiple informants (usually ASRS and something else)
- ADOS-2 (often needed for kids to get access to ABA services by insurances)
- I use a rip off of the ADI-R to qualitatively probe behaviors
- Def include IQ testing (because of criterion E - symptoms are "not better explained by ID"). Or try too...
- A measure of adaptive functioning (often needed to get services from the state dept of dev. disabilities to document significant functional limitations)
- Maybe some of social cog/theory of mind parts of NEPSY and some of the EF stuff if ADHD is suss.
But, you might not need an eval to dx ASD - but you absolutely need one to get the kid services. A lot of my evals are just jumping through hoops to get the kid services/aba and the kid clearly has ASD. All states differ tho.
I'd be interested in
@ClinicalABA's process for his littles. Am I the only one that feels like it's easier to dx in younger
I think little ones (under 3) are much easier than older kids. Much fewer rule outs/differential dx. I'm typically looking to distinguish between ASD and language disorder (both with/without ID), and plain old global delays in development. Itvcan be little tougher for thec1-2 year olds, as a few months delay in overall development can look like more than it is, socially and language wise, plus under 18 months and you're not really expecting pretend/ imaginative play or complex social language. My typical eval for a 30- 42 month old includes:
-ADOS-2 (to identify symptoms of ASD)
-Bayley-4 cognitive and language scales (for differential dx and also helping determine determine level of ASD and need for specific speech interventions)
-Vineland-3 completed by parent ( identify impacts of any delays/disorders, as well as get some measures of things I can't see in office, such as ADL skills)
-SRS-2 completed by parent ( further identification of potential ASD symptoms I might not see in-office, with a nice distinction between different areas of social responsiveness)
-interview with caregivers and early intervention staff
Kids between 24-30 months I substitute the BASC-3 for the SRS-2 due to minimum age of srs-2. Under 24 months I don't do either, as they aren't normed that young.
Over 42 months up to 5yo (oldest I'd typically see), sub the WPPSI-IV for the Bayley cognitive. If non-phrase speech, I'd sub the PLS-5 for the Bayley Language. If phrase speech, I might use the CASL instead- it gives better distinction between different areas of language (rather than just expressive and receptive). If theres a compelling reason, I might use the Stanford-Binet -5 or Leiter instead of WPPSI-IV. If kiddo is in school for more than few months, I'll have teachers complete the SRS-2 as well. If things like anxiety, attention problems are suspected, I might add in a BRIEF or BASC-3. 48 months plus, I might add in a Beery VMI and some NEPPSY subtests- generally comprehension of instructions, narrative memory, affect recognition, and theory of mind ( though I see a lot of ASD kids who do well on Affect recognition and TOM subtext who can't apply those skills).
Kids under 42 months with suspected contributing motor delays I might do Bayley-4 motor scales. Older kiddos I'll refer to PT/OT for eval, as that's beyond my zone of comfortabilty and I lack the equipment.
